Use of Breast MRI Offers Optimized Care

Magnetic resonance imaging (MRI) is being used increasingly for breast cancer screening, diagnostic assessment, treatment planning, and monitoring; however, a recent study revealed that over time, the indication for breast MRI has changed. Much of the increase was found among women with breast cancer risk factors, but there are still significant gaps in risk-based use.

The study’s findings were published January 1, 2014, in JAMA Internal Medicine. Tracy L. Onega, PhD, associate professor of Community and Family Medicine and of the Dartmouth Institute, Geisel School of Medicine at Dartmouth (Hannover, NH, USA) , and Norris Cotton Cancer Center member, is a coauthor of the article. The findings suggest the continued need for evidence that will help link the use of breast MRI, mammography, and newer imaging technologies such as digital breast tomosynthesis with the most effective care.

The study utilized data on breast MRI and mammography gathered by five US Breast Cancer Surveillance Consortium registries from 2005 to 2009—including the New Hampshire Mammography Network. It included 8,931 breast MRI scans and 1,288,924 screening mammograms from women aged 18 to 79 years. Investigators discovered that in this period the overall rate of breast MRI nearly tripled. The most common clinical indication was diagnostic evaluation (40.3%), followed by screening (31%).

“The benefit of breast MRI includes high sensitivity for identifying breast malignancy, and national guidelines support using it for particular clinical indications,” said Dr. Onega. “But compared to mammography, breast MRI is more expensive and can lead to higher false-positive rates. We need to continue to evaluate and compare the effectiveness of how MRI and mammography are used and find ‘the right test for the right woman at the right time.’”

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Geisel School of Medicine at Dartmouth University